Multifunction warming device with an upper body convective apparatus

ABSTRACT

A multifunction warming device includes a clinical garment having an inside surface supporting a convective apparatus disposed to provide therapeutic warming of a patient&#39;s upper body during surgery. The warming device includes a clinical garment with an elongate convective apparatus supported on the inside of the garment, transversely to the garment, and running between its sleeves. The positioning of the convective apparatus in the clinical garment locates it against the chest of a patient wearing the garment and permits it to be deployed and used on the patient&#39;s upper body during and after surgery without removal of the clinical garment from the patient or removal of the convective apparatus from the clinical garment.

RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.11/583,481, filed Oct. 19, 2006, which claims priority to U.S.Provisional patent application 60/729,000, filed Oct. 20, 2005 and toU.S. Provisional patent application 60/835,602, filed Aug. 4, 2006.

This application contains subject matter related to the subject matterof the following patent applications, all commonly owned herewith andall incorporated by reference:

Patent Cooperation Treaty (PCT) Application No. PCT/US03/011128, filedApr. 10, 2003, entitled “Patient Comfort Apparatus and System”, andpublished on Oct. 23, 2003 under Publication No. WO 2003/086500;

Patent Cooperation Treaty (PCT) Application No. PCT/US05/025355, filedJul. 18, 2005, entitled “Perioperative Warming Device”, and published onFeb. 23, 2006 under Publication No. WO 2006/020170;

Patent Cooperation Treaty (PCT) Application No. PCT/US05/043968, filedDec. 6, 2005, entitled “Warming Device with Varied Permeability”, andpublished on Jun. 15, 2006 under Publication No. WO 2006/062910;

Patent Cooperation Treaty (PCT) Application No. PCT/US05/044214, filedDec. 6, 2005, entitled “Warming Device”, and published on Jun. 15, 2006under Publication No. WO 2006/063027;

Patent Cooperation Treaty (PCT) Application No. PCT/US06/004644, filedFeb. 9, 2006, entitled “Warming Device for Perioperative Use”, andpublished on Aug. 17, 2006 under Publication No. WO 2006/086587;

U.S. patent application Ser. No. 10/411,865, filed Apr. 10, 2003,entitled “Patient Comfort Apparatus and System” and published on Oct.16, 2003 under Publication No. US 2003/0195596 and issued on Feb. 21,2006 under U.S. Pat. No. 7,001,416;

U.S. patent application Ser. No. 10/508,319, filed Sep. 20, 2004,entitled “Patient Comfort Apparatus and System” and published on Jun.30, 2005 under Publication No. US 2005/0143796;

U.S. patent application Ser. No. 11/005,883, filed Dec. 7, 2004,entitled “Warming Device with Varied Permeability” and published on Jun.8, 2006 under Publication No. US 2006/0122671, now U.S. Pat. No.7,226,454;

U.S. patent application Ser. No. 11/006,491, filed Dec. 7, 2004,entitled “Warming Device” and published on Jun. 8, 2006 underPublication No. US 2006/0122672;

U.S. patent application Ser. No. 11/057,396, filed Feb. 11, 2005,entitled “Perioperative Warming Device”, and published on Aug. 17, 2006under Publication No. US 2006/0184215, now U.S. Pat. No. 7,276,076;

U.S. patent application Ser. No. 11/057,403, filed Feb. 11, 2005,entitled “Warming Device for Perioperative Use”, and published on Aug.17, 2006 under Publication No. US 2006/0184217;

U.S. patent application Ser. No. 11/057,404, filed Feb. 11, 2005,entitled “Clinical Garment for Comfort Warming and Prewarming”, andpublished on Aug. 17, 2006 under Publication No. US 2006/0184218; and,

U.S. patent application Ser. No. 11/363,136, filed Feb. 27, 2006,entitled “Forced Air Warming Unit” and published on Jul. 6, 2006 underPublication No. US2006/0147320.

This application also contains subject matter related to the subjectmatter of the following patent applications, all commonly ownedherewith:

PCT Application No. US/2006/41028, filed Oct. 19, 2006, entitled“Multifunction Warming Device for Perioperative Use”, and published onApr. 26, 2007 under Publication No. WO2007/047917;

PCT Application No. PCT/US2007/013073, filed Jun. 1, 2007, titled“Warming Device”, and published Jan. 31, 2008 under Publication No. WO2008/013603;

PCT Application No. PCT/US2008/000141, filed Jan. 4, 2008, titled“Convective Warming Device with a Drape”, and published Jul. 31, 2008under Publication No. WO 2008/091486;

U.S. patent application Ser. No. 10/895,672, filed Jul. 21, 2004,entitled “Perioperative Warming Device”, now abandoned, published onJan. 20, 2005, under Publication No. US 2005/0015127;

U.S. patent application Ser. No. 11/057,397, filed Feb. 11, 2005,entitled “Thermal Blanket for Warming the Limbs”, and published on Aug.17, 2006 under Publication No. US 2006/0184216, now U.S. Pat. No.7,520,889;

U.S. patent application Ser. No. 11/492,425, filed Jul. 25, 2006,entitled “Warming Device”, and published on Nov. 16, 2006 underPublication No. US 2006/0259104;

U.S. patent application Ser. No. 11/583,432, filed Oct. 19, 2006,entitled “Multifunction Warming Device for Perioperative Use”, andpublished on Apr. 26, 2007 under Publication No. US/2007/0093882;

U.S. patent application Ser. No. 11/583,480, filed Oct. 19, 2006,entitled “Multifunction Warming Device with Provision for WarmingHands”, and published on Apr. 26, 2007 under Publication No.US/2007/0093884;

U.S. patent application Ser. No. 11/583,481, filed Oct. 19, 2006,entitled “Multifunction Warming Device with an Upper Body ConvectiveApparatus”, and published on Apr. 26, 2007 under Publication No.US/2007/0093885;

U.S. patent application Ser. No. 11/656,777, filed Jan. 23, 2007,entitled “Convective Warming Device With a Drape”;

U.S. patent application Ser. No. 11/704,547, filed Feb. 9, 2007,entitled “A Forced Air Warming Unit”;

U.S. patent application Ser. No. 11/801,292, filed May 9, 2007, titled“Warming Device with Varied Permeability”, and published on Oct. 11,2007 under Publication No. US 2007/023939;

U.S. patent application Ser. No. 11/899,872, filed Sep. 7, 2007,entitled “Perioperative Warming Method”; and published on Jan. 31, 2008under Publication No. US 2008/0027522;

U.S. patent application Ser. No. 11/899,928, filed Sep. 7, 2007,entitled “Perioperative Warming Device” and published on Jan. 31, 2008under Publication No. US 2008/0027521;

U.S. patent application Ser. No. 12/011,699, filed Jan. 1, 2008, titled“Warming Device” and published on Jun. 11, 2009 under Publication No. US2009/0149931;

U.S. patent application Ser. No. 12/386,243, filed Apr. 15, 2009, titled“Warming Device with Provisions for Deploying Elements of an Upper BodyConvective Apparatus and for Deploying the Lower Portion of the WarmingDevice” and published on Sep. 10, 2009 under Publication No. US2009/0228083; and

U.S. patent application Ser. No. 12/653,825, filed Dec. 21, 2009, titled“Warming Device Constructions with a Poncho-Type Patient Gown”.

BACKGROUND

The field covers a multifunction warming device including a clinicalgarment with an elongate convective apparatus supported on the inside ofthe garment, transversely to the garment, running between its sleeves.

In this specification, use of the term “convective” to denote thetransfer of heat from a device to a body refers to the device'sprincipal mode of heat transfer, it being understood that heat may atthe same time be transferred from the device to the body by conductionand radiation, although not to the degree of convection.

Convective devices that transfer heat to a human body are known. Forexample, there are devices that receive a stream of pressurized, warmedair, inflate in response to the pressurized air, distribute the warmedair within a pneumatic structure, and emit the warmed air onto a body toaccomplish such objectives as increasing comfort, reducing shivering,and treating or preventing hypothermia. These devices are typicallycalled “convective thermal blankets” or “covers”; for convenience, inthis discussion and the following specification, they shall be called,simply, “thermal blankets.” Arizant Healthcare Inc., the assignee ofthis application, makes and sells such devices under the BAIR HUGGER®brand. One such device is the Model 522 Upper Body Blanket.

Thermal blankets have been specifically designed for particulardeployments where therapeutic warming is indicated. Three representativethermal blankets known in the prior art are shown in FIGS. 1A-1D. A“full body” thermal blanket 10 is shown in FIG. 1A. The full bodythermal blanket is adapted to lie upon a person and to extendlongitudinally along the body of the person in order to coversubstantially the person's entire body, from near the ankles or feet upto the neck. A “lower body” thermal blanket 12 is shown in FIG. 1B. Thelower body thermal blanket 12 is adapted to lie upon the person and toextend longitudinally along the body of a person in order to cover theperson's lower body, from near the ankles or feet up to the waist orpelvis of the person. An “upper body” thermal blanket 15 is illustratedin FIGS. 1C and 1D. The upper body thermal blanket 15 has a bow-tieshape that is adapted to lie upon and extend transversely across theupper body of a person in order to cover the person's chest and extendedarms. A head drape 16 may be formed on or attached to the upper bodythermal blanket 15 for draping over the head 17 of a person in order toretain warmed air expelled through the blanket 15 about the head to aidin therapeutic warming during surgery. When fed a stream of warmedpressurized air, each of the thermal blankets 10, 12, 15 inflates anddistributes the air within itself. While the thermal blanket lies on theperson, the warmed pressurized air flows through apertures orinterstices in a permeable surface of the thermal blanket which facesthe person. These thermal blankets may have one, two, or more inletports 18 through which an air hose 19 provides warmed pressurized airfrom a heater/blower unit (not shown in these drawings).

The construction of thermal blankets is well understood. Examples ofspecific constructions are given in U.S. Pat. No. 5,620,482, U.S. Pat.No. 5,443,488, U.S. Pat. No. 5,360,439, and U.S. Pat. No. 5,304,213. Seealso U.S. Pat. No. 5,974,605.

Clinical garments such as hospital gowns are widely used when patientsremove clothes in preparation for surgery. A hospital gown provides adisrobed patient with privacy and dignity before and after surgery, andoften remains on the patient throughout the surgical cycle. The utilityof clinical garments has been expanded by a recent invention disclosedin the referenced Publication No. WO 2003/086500. The inventiondescribed in the publication adapts a clinical garment such as a robe orgown to receive a convective device such as a thermal blanket in orderto warm a person wearing the garment in a clinical setting for comfortand mobility of the person. An invention covering a multifunctionwarming device for perioperative use is described in the referencedPublication US 2006/0122671 wherein a warming device is constituted of aclinical garment and a convective apparatus adapted for comfort andtherapeutic warming that is supported on the inside surface of thegarment.

The term “perioperative” is defined in the PDR Medical Dictionary,Second Edition, (Medical Economics Company, 2000), as “around the timeof operation.” The perioperative period is characterized by a sequenceincluding the time preceding an operation when a patient is beingprepared for surgery (“the preoperative period”), followed by the timespent in surgery (“the intraoperative period”), and by the timefollowing an operation when the patient is closely monitored forcomplications while recovering from the effects of anesthesia (“thepostoperative period”).

According to Mahoney et al. (Maintaining intraoperative normothermia: Ameta-analysis of outcomes with costs. AANA Journal. 4/99; 67,2:155-164.), therapeutic warming is employed during at least theintraoperative period in order to prevent or mitigate effects thatresult from hypothermia. In fact, it is increasingly manifest thatmaintenance of normothermia perioperatively enhances the prospects for aquick, successful recovery from surgery. For example, maintenance ofperioperative normothermia appears to be a factor in decreasing theincidence of surgical wound infections in patients undergoing colorectalsurgery, (Kurz A, Sessler D I, Lenhardt R. Perioperative normothermia toreduce the incidence of surgical-wound infection and shortenhospitalization. Study of Wound Infection and Temperature Group. N EnglJ. Med. May 9, 1996; 334(19):1209-1215). Other studies suggest thatmaintenance of perioperative normothermia improves surgical outcomes atlow cost, (Harper C M, McNicholas T, Gowrie-Mohan S. Maintainingperioperative normothermia. BMJ. Apr. 5, 2003; 326(7392):721-722). Theeffectiveness of therapeutic warming depends upon delivery of enoughheat to a patient's body to raise the patient's core body temperatureto, or maintain it within, a narrow range, typically around 37° C. Thisrange is called “normothermic” and a body with a core temperature inthis range is at “normothermia.” Hypothermia occurs when the core bodytemperature falls below 36° C.; mild hypothermia occurs when core bodytemperature is in the range of 34° C. to 36° C. Therefore,“perioperative therapeutic warming” is warming therapy capable of beingdelivered during one or more of the perioperative periods for theprevention or treatment of hypothermia.

Therapeutic warming is contrasted with “comfort warming” which isintended to maintain or enhance a patient's sense of “thermal comfort”.Of course, therapeutic warming may also comfort a patient by alleviatingshivering or a feeling of being cold, but this is a secondary orancillary effect; and, comfort warming may have some therapeutic effect.However, even though thermal comfort is a subjective notion,environmental conditions that produce a sense of thermal comfort in apopulation of human beings are known and well tabulated. For example,Fanger (Thermal Comfort: Analysis and Applications of EnvironmentalEngineering, Danish Technical press, Copenhagen, 1970) defines thermalcomfort as “that condition of mind which expresses satisfaction with thethermal environment.” Even when a patient is normothermic, less thanideal environmental conditions can result in acute feelings ofdiscomfort. Under normothermic conditions, thermal comfort is largelydetermined with reference to skin temperature, not core bodytemperature. Comfort warming is warming applied to a patient toalleviate the patient's sense of thermal discomfort.

Therapeutic warming may be indicated during any one or more of theperioperative periods. For example, for a short operation in a surgerywith no warming equipment available, a person may be warmedpreoperatively in a preparation area to raise mean body temperature to alevel higher than normal in order to store enough thermal energy tomaintain normothermia, without heating, intraoperatively. After surgery,it may be necessary to apply therapeutic warming in a recovery area toraise the core temperature to normothermia and maintain it there for aperiod of time while anesthesia wears off. Alternatively, for a longsurgery in an arena with heating equipment available, a person may bewarmed for comfort before surgery and warmed therapeutically during andafter surgery.

Therapeutic warming is typically provided by convective devices such asthe thermal blankets shown in FIGS. 1A-1D. An example of use of a fullbody thermal blanket for therapeutic warming is found in U.S. Pat. No.6,524,332, “System and Method for Warming a Person to Prevent or TreatHypothermia”, commonly owned with this application.

The upper body thermal blanket 15 shown in FIGS. 1C and 1D is frequentlyused during thoracic, abdominal and pelvic surgery and/or in the postanesthesia care unit (PACU) to satisfy the need for therapeutic warming.As is known, a patient's core body temperature can drop to hypothermiclevels quickly during surgery. To prevent or mitigate the effects ofhypothermia, an upper body blanket may be deployed for therapeuticwarming during the intraoperative period. However, the need fortherapeutic warming often is ascertained only after surgery commencesand it is inconvenient, and sometimes it is not possible, to interruptattendance on a patient during a surgical procedure in order to locateand deploy a thermal blanket and bring it into operation. In such cases,therapeutic warming can be delayed until the patient enters the PACU,when the patient may have been hypothermic for a significant period oftime. Given the frequency with which upper body thermal blankets areused during and after surgery, it would be very useful and clinicallybeneficial to conveniently position an upper body convective device withrespect to a patient so that it could be quickly accessed and deployedduring thoracic, abdominal, or pelvic surgery with little or no timespent in retrieval.

A warming device combining a clinical garment with a convective insertto provide comfort warming does not provide for therapeutic warmingduring thoracic surgery. Thus, even for a patient wearing a clinicalgarment with a convective apparatus as disclosed in WO 2003/086500, anupper body thermal blanket must be unpackaged, made ready and deployedduring such surgery. Warming may be indicated postoperatively in orderto stave off hypothermia while the patient's recuperation proceeds.Manifestly, a substantial convenience and a significant gain in apatient's physical condition would result from use of a warming devicecapable of clothing a patient preoperatively, while positioning aconvective apparatus to therapeutically warm the patient duringthoracic, abdominal, or pelvic surgery and postoperatively. Because ofwide-spread and frequent use, it would be particularly desirable to havea multifunction warming device constituted of a clinical garment with aconvective apparatus supported on the inside of the garment for easydeployment and use in warming a patient's upper body.

The assignee's Publication US 2006/0184217 published Aug. 17, 2006discloses a warming device for perioperative use in which thermalblankets are attached to the inside surface of a clinical garment.However, use of the thermal blankets for therapeutically warming apatient wearing the clinical garment requires either that the thermalblanket be detached from the inside surface and repositioned for use, orthat the clinical garment be removed from the patient and repositionedin order to correctly orient the thermal blanket with respect to thepatient. In either case, the extra steps to access the thermal blanketfor operation complicate use of the warming device, and consume timeotherwise spent tending to the patient.

The deterrents to adoption of the warming device disclosed in US2006/0184217 are eliminated by disposing an elongate convective thermalblanket for upper body use on the inside of the clinical garment,transversely to the garment, between its sleeves, with its permeablesurface facing the patient. This positioning of the convective apparatusin the clinical garment locates it against the chest of a patientwearing the garment and permits it to be deployed and used on thepatient during and after surgery without removal of the clinical garmentfrom the patient, without removal of the convective apparatus from thegown, and without reorientation of the clinical garment in order tocorrectly orient the convective apparatus with respect to the patient.

SUMMARY

A multifunction warming device includes a clinical garment having aninside surface supporting a convective apparatus disposed to providetherapeutic warming of a patient's upper body during surgery. Thewarming device includes a clinical garment with an elongate convectiveapparatus supported on the inside of the garment, transversely to thegarment, and running between its sleeves. The positioning of theconvective apparatus in the clinical garment locates it against thechest of a patient wearing the garment and permits it to be deployed andused on the patient's upper body during and after surgery withoutremoval of the clinical garment from the patient or removal of theconvective apparatus from the gown.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A-1D are illustrations of prior art full body, lower body, andupper body convective thermal blankets.

FIG. 2 is an illustration of a person wearing a multifunction warmingdevice.

FIG. 3A is a perspective view from behind a clinical garment, with theclinical garment partially opened to show an inside surface thatsupports two convective warming apparatuses.

FIGS. 3B and 3C are plan views of the convective apparatus used in themultifunction warming device. FIG. 3C shows details of folding elementsof the convective apparatus.

FIG. 3D is a plan view of the convective apparatus of FIGS. 3B and 3Cwith portions of its sleeves folded.

FIG. 3E is an enlarged, partially schematic drawing showing an operationof an attachment mechanism.

FIG. 3F is a rear elevation view of a multifunction warming device forperioperative use.

FIGS. 4A-4C illustrate preparation and deployment of a multifunctionwarming device for perioperative use to therapeutically warm a patient.

FIGS. 5A-5E are views of the front of the left sleeve of the clinicalgarment, looking toward the front surface of the clinical garment,showing lines of weakness that may be operated to provide access to endsof the first convective apparatus.

SPECIFICATION

A multifunction warming device for perioperative use is constituted of aclinical garment and at least one convective apparatus supported on aninside surface of the garment. In this regard, a “clinical garment” is agarment that is typically used to temporarily clothe a patient in aclinical setting. Such garments include hospital gowns, robes, bibs andother equivalents. The clinical setting may be a medical or dentaloffice or clinic, a hospital, or any facility or institution thatprovides medical or dental treatment to patients. A convective apparatusreceives and distributes at least one stream of warmed pressurized airin a structure for being disposed on, adjacent, or next to the coreand/or the limbs of a body. When pressurized with warmed air, aconvective apparatus emits warmed air through one or more permeablesurfaces.

In one aspect, a multifunction warming device for perioperative use maybe worn on a person where it receives a stream of warmed pressurizedair, distributes the pressurized air within a convective apparatus, andemits the air through one or more surfaces of the convective apparatusto warm the person's body.

In another aspect, the multifunction warming device may be adapted fortherapeutic warming during surgery. In this regard, the multifunctionwarming device may be adapted for therapeutic warming by deploying aconvective apparatus for use intraoperatively while the clinical garmentis furled so as not to intrude on the surgical site.

In the warming device illustrated and discussed below, convectiveapparatuses are inflatable. That is, their structures, flaccid when notin use, tauten when receiving a stream of pressurized air.

Although a single convective apparatus is set forth in the followingdescription and shown in the illustrations, this is not meant to excludethe provision of one or more additional convective apparatuses providedon the inside surface of the clinical garment for comfort or therapeuticwarming. Thus, reference will be made in the specification and theclaims which follow to “one or more” convective apparatuses.

Refer now to the figures, in which a person 11 wearing a multifunctionwarming device 20 for perioperative use is illustrated in FIG. 2. Thewarming device 20 is constituted of a clinical garment 22 and at leastone convective apparatus (not seen in this view) supported on an insidesurface of the clinical garment 22. The convective apparatus may beoperated by receiving warmed, pressurized air from a heater/blower unit(not seen in this view) through an air hose with a nozzle that isreceived in an inlet port of the convective apparatus. The inlet port isaccessed through a flap 29 in the clinical garment 22. Other inlet ports(not shown) may be accessed through other flaps in the clinical garment(not shown).

FIGS. 3A-3D illustrate the elements of a multifunction warming devicefor perioperative use; the assembled multifunction warming device 20 isitself illustrated in FIG. 3E. The view in FIGS. 3A and 3F is from therear of the clinical garment 22, looking toward the inside surface ofthe garment, which faces the chest, or thorax of a patient and on whichat least one convective apparatus is mounted. FIGS. 3B through 3D areplan views of an uninflated convective apparatus, looking toward apermeable surface through which air is expelled toward a patient whenthe blanket is inflated. As seen in FIGS. 3A and 3F, the warming device20 includes the clinical garment 22. The clinical garment 22 includes aninside surface 43, two opposing lateral hems 45, a lower hem 47, and alongitudinal axis 49. The clinical garment 22 has an upper portion 51with two opposing sleeves 53 (also seen in FIG. 2) and a scooped upperedge 54, and a lower portion 55. The flap 28 that provides access to aninlet port through the front of the garment 22 is also visible in FIG.3A. The sleeves 53 may be long or short. Short sleeves are preferred ifaccess must be had to a person's arms for instrumentation and/or IVdelivery. Each sleeve 53 includes an elongate seam 56 (both seen closedin FIG. 2). Each seam 56 may be held closed by means 57 including, forexample, buttons, snaps, hook and loop material, tape, and/or straps, orany equivalent thereof. Such means can be operated to let a seam 56 beopened and to again close a seam, once opened. Cuffs 58 may be formed inthe clinical garment 22 inside the sleeves 53, near the ends of thesleeves 53. The clinical garment 22 may open on a side. Preferably, theclinical garment 22 opens in the rear. The opening may be full, asillustrated in FIG. 3A, or it may be a slit rising from the lower hem47. As per the example shown in FIG. 3A, the opening may be closed bymeans 59 s along the lateral hems 45 which releasably connect to keepthe hems together. Such means may include, for example, buttons, snaps,hook and loop material, tape, and/or straps, or any equivalent thereof.In keeping with the example of FIG. 3A, if straps are used to close theopening, the straps may be attached to the clinical garment 22, orformed integrally therewith as a step in manufacturing the clinicalgarment 22. For example only, two integrally-formed straps 59 s fortying the opposing lateral hems 45 together in the upper portion 51 areseen in FIG. 3A. Two additional straps may be attached to the outsidesurface of the clinical garment 22 with enough reach to be tied togetheraround the outside of the clinical garment, near its middle. With enoughoverlap of the lateral hems 45, the opening in the clinical garment 22can be completely closed and secured, with the lateral hems overlappingto afford concealment of a patient's private parts. The clinical garment22 may be constructed from non-woven or woven materials. Preferably, theclinical garment 22 is made from a non-woven blend of spunlace polyesterand wood pulp

In FIG. 3B, an elongate convective apparatus 60 is shown fully openedfor deployment to provide therapeutic warming. In FIG. 3C, elements ofthe convective apparatus 60 are shown folded. The view in both figuresis toward a permeable surface of the convective apparatus 60 throughwhich heated air is expelled when the blanket is inflated. As seen inthese figures, the convective apparatus 60 includes an inlet port 61,two laterally-extending arms 62, each transitioning to a respective end63, a permeable surface 64, and a lower edge 65. Each end 63 has agenerally quadrilateral configuration with a periphery 63 p. Typically,the periphery 63 p includes a seal with some width. In some aspects ofthe convective apparatus 60, ties 63 t may be integrally formed ordefined in the peripheries 63 p by lines of weakness or perforations 63w. One tie 63 t is shown in dashed outline in FIG. 3B separated from theperiphery 63 p in which it is formed. Such ties may be used when theconvective apparatus 60 is deployed for use in securing the convectiveapparatus 60. As can be appreciated, from the separated tie 63 t, thearcuate shape near the end of the tie provides easy handling for tyingto another tie, to a patient, or to equipment in the surgical area. Seethe assignee's U.S. Pat. No. 5,773,275 in this regard. Optionally, slits63 s may be formed in seals near the outer edges of the ends 63. Theslits 63 s may be defined in the seals by lines of perforations. Ifprovided, the slits 63 s may be opened to be used as purchase holds forunfurling the ends 63 and/or for receiving the hands on the outstretchedarms of a patient in order to anchor or secure the ends 63 such as whenthe convective apparatus 60 is inflated and operated.

For stowing the convective apparatus 60 prior to use, the opposing sidesof the ends 63 may be folded toward each other as indicated by thearrows 68 a in FIG. 3B, and then folded as indicated by the arrow 68 bin FIG. 3C. The folds 68 reduce each end 63 to a length that fits in arespective sleeve 53 of the clinical garment 22. The folds arepreferably made so as to be easily tucked between the clinical garment22 and the convective apparatus 60. The ends of the foldedconfigurations may be retained in the inside cuffs 58 in the sleeves ofthe clinical garment 22. This allows the patient to insert an armthrough the sleeve of the clinical garment 22 without catching thecorresponding hand on the fold and inadvertently deploying the extendedside. Preferably, the ends 63 are folded by a Z-fold, although agatefold, accordion fold or any equivalent fold may be used. Moregenerally, the ends 63 may be folded, rolled or gathered in any way thatachieves the desired length reduction and neat compaction useful forstowing and retaining the ends 63 in the cuffs 58, and unfolding themwhen the convective apparatus is to be used for therapeutic warming. Theconvective apparatus 60 has a line of weakness or perforation thatextends transversely at 69 between each end 63 and a respectivelaterally-extending side 62.

With further reference to FIGS. 3B and 3C, in some aspects theconvective apparatus 60 may include an attachment mechanism, preferablyin the form of double-sided tape 66. Preferably, the double-sided tape66 is attached on one side of the convective apparatus 60 to a sealedlower portion of the permeable surface 64 of the convective apparatus60, along the lower edge 65, centered between the ends 63. Referring toFIG. 3B, the surface 66 b of the double-sided tape 66 that is visible iscovered with a non-adhesive backing that can be stripped off to exposethe adhesive with which both sides of the tape are covered. Forconvenience, the sealed lower portion of the permeable surface 64 where,the attachment mechanism is mounted may be surrounded by a perforation66 p which allows either side of the attachment mechanism to be detachedfrom the sealed lower portion and permit the attachment mechanism topivot on its longitudinal edge. The perforation 66 p also permits theattachment mechanism to be removed after use.

With reference to FIGS. 3B and 3C, although one inlet port 61 isillustrated in the convective apparatus 60, one or more additional inletports may be provided for convenience. Unused inlet ports are sealed orclosed by known means to prevent air escaping therethrough. Preferablythe inlet port 61 is provided through the surface of the convectiveapparatus 60 which is not visible in this figure; it may also beprovided through an edge of the convective apparatus 60. The inlet port61 may comprise a collar 61 a of stiff material with an opening 61 b toreceive the nozzle of an air hose, or it may comprise a sleeve ofmaterial, or any other equivalent structure. When the convectiveapparatus 60 is used for therapeutic warming, the ends of the sleevesare removed from the cuffs 58 and unfolded. Then, warmed pressurized airflowing through an inlet port such as the inlet port 61 inflates theconvective apparatus 60, from its central portion to its ends 63.

An operation for deploying the double-sided tape for use is shown inFIG. 3E. The double-sided tape 66 is adhered, on one side, to theconvective apparatus 60 centered along the lower edge 65. Backing 66 bis mounted to the surface of the tape 66 that faces a patient wearingthe warming device 20. When the tape 66 is deployed for use, the twoshort sections of the perforation 66 p (best seen in FIGS. 3B and 3C)may be torn. This permits the portion of the convective apparatus 60 towhich the double-sided tape 66 is attached to pivot on its longitudinaledge so that the lower edge 65 with the double-sided tape 66 mountedtherealong may be swung toward and away from the patient. The backing 66b may be stripped off and the tape 66 may be adhesively attached to theskin of the patient, thereby anchoring the warming device 20 and/or theconvective apparatus 60. As explained hereinabove with reference toFIGS. 3B and 3C, the double-sided tape 66 may be removed after use bytearing along the long section of the perforation 66 p. Alternatively,the tape 66 may be rotated behind the lower edge 65, between theconvective device 60 and the inside surface 43, once the tape has beenreleased from the patient.

A head drape 87, shown unfurled in FIG. 3E and furled or folded in FIGS.3A-3D, preferably constituted of a sheet of clear plastic, may beattached to the inside surface 43 of the clinical garment 22, near thescooped upper edge 54 (shown in FIG. 3A) or may be attached near theupper edge of the convective apparatus 60 on the surface which faces theinside surface 43 (shown in FIGS. 3B through 3D).

FIG. 3F shows a multifunction warming device 20 for perioperative useassembled from the elements illustrated in FIGS. 3A-3E. As illustratedin FIG. 3F, the convective apparatus 60 is an elongate convectiveapparatus disposed, supported, or constructed on the inside surface 43of the clinical garment 22, in the upper portion 51, transverse to thelongitudinal axis 49 and extending from sleeve 53 to sleeve 53.Preferably, the convective apparatus 60 is an upper body convectiveapparatus having the construction illustrated in FIGS. 3B and 3C, withits ends 63 folded and retained in the inside cuffs 58. An opening inthe upper portion 51 of the clinical garment 22 (such as the flap 29 inFIGS. 2 and 3A) provides access by which an air hose can connect to oneor more inlet ports such as the inlet port 61 of the convectiveapparatus 60 in order to operate the blanket for therapeutic warming. Inuse, warmed, pressurized air flows into and inflates the convectiveapparatus 60, and exits through the permeable surface 64 toward apatient.

The convective apparatus 60 may be formed by joining two sheets ofmaterial with a closed impermeable seam around their peripheries. One ofthe sheets is relatively impermeable and the other sheet is relativelymore permeable to permit airflow therethrough. The sheets are furtherconnected by discontinuous seals or stake points within the closedimpermeable seams. The two sheets with which a convective apparatus isformed may be separate from the clinical garment 22, in which case theconvective apparatus is permanently or releasably attached, fixed, oradhered to the inside surface 43 of the clinical garment 22, with itspermeable surface facing inwardly, toward a patient wearing the device20. An exemplary construction in this regard is illustrated in FIGS. 1Aand 1D and FIGS. 3A-3C of PCT publication WO 2003/086500. Alternately,the convective apparatus 60 may be formed or constructed integrally witha clinical garment 22 made of relatively impermeable material byattaching a relatively permeable sheet to a portion of the insidesurface of the clinical garment 22. An exemplary construction in thisregard is illustrated in FIGS. 1D and 1E and FIGS. 3D-3F of PCTpublication WO 2003/086500.

According to the present best mode of construction of the multifunctionwarming device for perioperative use, the convective apparatus is formedor assembled separately from the clinical garment and then attached toits inside surface by sewing, gluing, heat sealing, or welding, or anycombination of these. The convective apparatus 60 is formed by heatsealing two sheets of material together. The sheets include a laminatesheet comprising a layer of nonwoven material on which a layer ofpolypropylene is extruded, and a polypropylene film. Apertures areformed through the laminate sheet to render it permeable and thepolypropylene layers are sealed around their peripheries to form theconvective apparatus 60. The side of the convective apparatus 60 withthe relatively non-permeable polypropylene film is attached to theinside surface of the clinical garment and the nonwoven material of thelaminate sheet faces the patient. The reason for locating thepolypropylene film on the inside surface of the clinical garment is toreduce the bulk and stiffness of the convective apparatus, thus makingthe warming device more comfortable to the patient.

When the multifunction warming device 20 is worn as shown in FIG. 2 forcomfort warming, a convective apparatus may be connected to aheater/bower unit via an air hose to receive a stream of warmedpressurized air. The convective apparatus inflates in response to thestream of air and emits air through its permeable surface. Themultifunction warming device 20 retains warmed air within the clinicalgarment 22 for comfort warming.

FIGS. 4A-4C illustrate how the multifunction warming device 20 isadapted for therapeutic warming by using the convective apparatus 60 inthe same manner as an upper body thermal blanket. The view in thesefigures is toward the front of the clinical garment 22, from a positionabove the patient, who is lying prone on an operating table (not shown),preferably one with cruciate support for the patient's arms. In FIG. 4A,a patient is shown wearing a warming device 20 as preparation commencesTies 100 hold the clinical gown 22 closed. In FIG. 4B, the ties 100 areuntied, and the head drape 87 is unfurled, as are the ends 63 of theconvective apparatus 60. A grasping target 88 (also seen in FIGS.3B-3D), or a tab, not shown, may be provided on a free upper edge of thehead drape 87 so that the drape may be grasped for deployment. The ends63 are freed from the cuffs 58, unfurled through the ends of the sleeves53 and unfolded to be positioned over the hands and wrists of thepatient.

In FIG. 4C, the flap 29 has been folded back to expose the inlet port 61of the convective apparatus 60 and a heater/blower unit (not shown) maynow be connected to the inlet port 61 via an air hose 70 and nozzle 71.As explained above in connection with FIG. 3E the double-sided tape 66is deployed for use. That is to say, the backing 66 b is pulled off thetape's outer surface. As seen in FIG. 4C, the ends 63 of the convectiveapparatus 60 and head drape 87 are fully unfurled, the tape 66 isadhesively attached to the patient's body, and the lower portion of theclinical garment 22 is furled or folded at 22 f, thereby removing thelower portion of the multifunction warming device 20 from the surgicalsite. FIG. 4C shows the convective apparatus 60, in the form of an upperbody convective device, deployed over and secured to the patient, andoperated thereat to provide therapeutic warming during thoracic,abdominal, or pelvic surgery. In operation, the convective apparatus 60is connected to an air hose 70, through a nozzle 71 received in theinlet port 61. The air hose is connected to a heater/blower unit (notshown) and inflates in response to a stream of air conducted through 70,71, and 61 from the heater/blower unit and emits warmed air through itspermeable surface toward the patient. The head drape 87 and unfurledends 63 trap warm air around the patient's head and hands, whichcontributes to maintaining the core temperature at or near normothermia.

With reference to FIG. 4C, after surgery, when the heater/blower unit isdisconnected from the convective apparatus 60, the ends 63 may beremoved along the perforations 69 seen in FIGS. 3B, 4C, and 5E, or theconvective apparatus 60 may left intact to continue being used forwarming in the postoperative period. The upper portion of the head drape87 may be detached along the line of perforations 89 seen in FIG. 4C, orthe head drape may be left intact to continue being used for warming inthe postoperative period. With reference to FIG. 4C, the furled portion22 f of the clinical garment 22 may be unfurled or unfolded from thecenter of the convective apparatus 60 toward the patient's feet therebyreconfiguring the clinical gown 22 to be worn again by the patient.Alternatively, if the patient is to be warmed postoperatively whilerecovering from anesthesia, the unfurled clinical gown 22 can serve as ablanket or drape over the patient to trap warm air about the patient.

The best current mode and preferred embodiment for unfurling the foldedends 63 of the convective apparatus through the ends of the sleeves 53may be understood with reference to FIGS. 5A-5E, in which the view istoward the front surface of the left sleeve of the clinical garment 22.Thus, although it uses the left sleeve for illustration, the followingexplanation also applies to a corresponding construction of the rightsleeve. FIG. 5A shows lines of weakness (preferably, perforations)formed in the sleeve 53 to enable access to an end 63 folded and tuckedinto a cuff 58. Two opposing lines of perforations 90 may be formed nearthe end of the sleeve 53, one in the front half of the sleeve, and anopposing one in the half of the cuff 58 that faces the front half of thesleeve. Alternately, a single line of perforations 91 may be formed ator near the end of the sleeve, where the sleeve transitions into thecuff 58. As best seen in FIG. 5B, the first pattern of perforations 90enables a user to tear away the end 93 of the front half of the sleeve53. The second pattern of perforations 91 permits a user to separate thetwo sides of the end of a sleeve, at or near the end of the sleeve 53 inthe manner illustrated in FIG. 5C. As seen in FIG. 5D, once the end of asleeve 53 is opened, the folded portion of the end 63 of the convectiveapparatus 60 can be pulled through the now-opened end of the cuff 58,through the end of the sleeve 53.

The best current mode for forming the cuffs 58 inside the sleeves 53with respect to lines of perforation 90 or 91 may be understood withreference to FIGS. 3A, 3D, 3F, and 5A-5C. In this regard, the preferredpattern of perforations is formed in the front halves of the sleeves 53of the clinical garment 22. The convective apparatus 60 is formedseparately from the clinical garment 22 as described above. Theconvective device 60 is brought against the inside surface 43 in thefully folded configuration shown in FIG. 3D, running between the sleeves53, with its impermeable surface facing the inside surface 43 and thefolded configurations of the ends 63 located therebetween. Theconvective apparatus 60 is attached to the inside surface 43 by lines ofadhesive bonding between its upper and lower edges and the portion ofthe inside surface in the front halves of the sleeves 53. Toward theends of the sleeves, the lines of adhesive bonding stop short of thefolded portions of the ends 63 and the perforations 90; in the directionof the longitudinal axis 49, the lines of bonding stop where the sleeves53 join the main body of the clinical garment 22. A line of adhesivestake points between the impermeable surface of the convective apparatus60 and the inside surface is provided just above the attachmentmechanism 66. The end of each sleeve 53 is then folded inwardly of thesleeve 52, toward and along the inside surface 43, far enough toposition the two lines of perforations 90 opposite each other, one lineinside and the other line outside of the sleeve, or to position thesingle line of perforations 91 at or near the transition to the insidecuff 58. Once folded, the end of each sleeve is attached inside thesleeve by a single elongate strip of adhesive bonding extendingtransversely across the sleeve. With reference to FIGS. 3A and 3D, thestrip of bonding for each cuff 58 may be as wide as the cuff. As may befurther appreciated with reference to these figures, the strip ofadhesive bonding along a cuff 58 runs between the cuff and a traceextending from a portion of the inside surface 43 in the sleeve 53 abovethe upper edge 62 of the convective apparatus 60, across a narrow stripof the permeable surface 64 of the convective apparatus 60 in the fronthalf of the sleeve, and across a narrow strip of the inside surface inthe back half of the sleeve. When the perforation pattern near or at theend of a sleeve 53 is opened, the user reaches into the space definedbetween the front of the sleeve and the impermeable surface of theconvective apparatus 60, grasps the folded end portion of the firstconvective device stowed therein, and unfolds the folded end portion outthrough the opening. This construction interferes minimally with theoperation of the convective apparatus 60 since the narrow strip ofadhesive bonding occludes only small strips of the permeable surface ofthe apparatus. At the same time, this construction serves to secure theends 63 of the convective apparatus 60 against movement with respect tothe sleeves 53 of the clinical garment 22.

A multifunction warming device is constituted of a clinical garment andat least one convective apparatus supported on an inside surface of thegarment. The convective apparatus is disposed transversely in an upperportion of the clinical garment, running between two sleeves of theclinical garment. With the convective apparatus supported on the insidesurface of the garment, the device can be worn by the patient before,during, and after surgery. In preparation for surgery, the convectiveapparatus is deployed for therapeutic warming while the clinical garmentis furled or folded over or around the deployed convective apparatus.

Advantageously, the transverse positioning of the convective apparatusin the upper portion of the clinical garment locates it against thechest of a patient wearing the garment, in proper orientation with thepatient's arms and upper chest, and permits it to be deployed and usedon the patient's upper body during and after surgery withoutreorientation of the clinical garment on the patient, removal of theclinical garment from the patient, or removal of the convectiveapparatus from the gown.

Although the invention has been described with reference to thepresently preferred embodiment, it should be understood that variousmodifications can be made without departing from the spirit of theinvention. Accordingly, the invention is limited only by the followingclaims.

1. A warming device, comprising: a clinical garment having an insidesurface and an upper portion with opposing sleeves; an upper bodyconvective apparatus attached to the inside surface in the upperportion; the upper body convective apparatus disposed transverselyacross the upper portion, along the sleeves; at least one inlet port inthe upper body convective apparatus; and a lower edge on the upper bodyconvective apparatus and an attachment mechanism along the lower edge;wherein: the upper body convective apparatus includes twolaterally-extending sides, each side disposed in a folded configurationin a respective sleeve; each sleeve includes an inside cuff retaining aside in the folded configuration, and one or more lines of perforationnear the cuff for being opened to provide access through the end of thesleeve to the side in the folded configuration; and, each side includesan end of the upper body convective apparatus, and each side beingextendable from the folded configuration to an unfolded configuration inwhich the respective end extends outwardly from the clinical garment. 2.The warming device of claim 1, further including means in each sleevefor releasably retaining a side in the folded configuration in thesleeve.
 3. The warming device of claim 2, each side including an end ofthe upper body convective apparatus, and each side being extendable fromthe folded configuration to an unfolded configuration in which the endextends outwardly from the clinical garment.
 4. The warming device ofclaim 1, wherein the upper body convective apparatus includesperforation lines extending transversely across each side to enable theseparation of the ends from the convective apparatus.
 5. A warmingdevice, comprising: a clinical garment having an inside surface and anupper portion with opposing sleeves: an upper body convective apparatusattached to the inside surface in the upper portion; the upper bodyconvective apparatus disposed transversely across the upper portion,along the sleeves; at least one inlet port in the upper body convectiveapparatus; and a head drape adjacent the upper surface, in the upperportion; wherein: the convective apparatus includes twolaterally-extending sides, each side disposed in a folded configurationin a respective sleeve; each sleeve includes an inside cuff retaining aside in the folded configuration, and one or more lines of perforationnear the cuff for being opened to provide access through the end of thesleeve to the side in the folded configuration; and, each side includesan end of the convective apparatus, and each side being extendable fromthe folded configuration to an unfolded configuration in which therespective end extends outwardly from the clinical garment.
 6. A warmingdevice, comprising: a clinical garment having an inside surface and anupper portion with opposing sleeves: an upper body convective apparatusattached to the inside surface in the upper portion; the upper bodyconvective apparatus disposed transversely across the upper portion,along the sleeves; the upper body convective apparatus including twolaterally-extending sides, each side disposed in a folded configurationin a respective sleeve, each side including an end of the convectiveapparatus, and each side being extendable from the folded configurationto an unfolded configuration in which the end extends outwardly from theclinical garment; means in each sleeve for releasably retaining a sidein the folded configuration in the sleeve; at least one inlet port inthe upper body convective apparatus; and a head drape adjacent the uppersurface, in the upper portion.
 7. The warming device of claim 6, whereinthe convective apparatus includes perforation lines extendingtransversely across each side to enable the separation of the ends fromthe convective apparatus.